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Markousis-Mavrogenis G, Pepe A, Bacopoulou F, Lupi A, Quaia E, Chrousos GP, Mavrogeni SI. Combined Brain-Heart Imaging in Takotsubo Syndrome: Towards a Holistic Patient Assessment. J Clin Med 2024; 13:2991. [PMID: 38792532 PMCID: PMC11122389 DOI: 10.3390/jcm13102991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Takotsubo syndrome (TTS) is a type of cardiomyopathy usually precipitated by either emotional or physical stress and potentially leading to reversible heart failure. There is emerging evidence indicating an interaction between the brain and the heart in patients with TTS. Nevertheless, these new insights are not reflected in the current clinical approach to TTS. The application of novel and existing imaging modalities for the evaluation of brain-heart interactions is an interesting approach that could potentially augment diagnostic and prognostic yield, as well as improve our pathophysiologic understanding in the context of TTS. In this opinion piece, we discuss the evidence supporting a brain-heart interaction in patients with TTS and discuss how a combined evaluation of brain-heart interactions could potentially be implemented.
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Affiliation(s)
- George Markousis-Mavrogenis
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (G.M.-M.); (F.B.); (G.P.C.)
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padova, 35128 Padova, Italy; (A.P.); (A.L.); (E.Q.)
| | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (G.M.-M.); (F.B.); (G.P.C.)
| | - Amalia Lupi
- Institute of Radiology, Department of Medicine, University of Padova, 35128 Padova, Italy; (A.P.); (A.L.); (E.Q.)
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine, University of Padova, 35128 Padova, Italy; (A.P.); (A.L.); (E.Q.)
| | - George P. Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (G.M.-M.); (F.B.); (G.P.C.)
| | - Sophie I. Mavrogeni
- University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (G.M.-M.); (F.B.); (G.P.C.)
- Onassis Cardiac Surgery Center, 17674 Athens, Greece
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Fogante M, Volpato G, Esposto Pirani P, Cela F, Compagnucci P, Valeri Y, Selimi A, Alfieri M, Brugiatelli L, Belleggia S, Coraducci F, Argalia G, Casella M, Dello Russo A, Schicchi N. Cardiac Magnetic Resonance and Cardiac Implantable Electronic Devices: Are They Truly Still "Enemies"? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:522. [PMID: 38674168 PMCID: PMC11051994 DOI: 10.3390/medicina60040522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
The application of cardiac magnetic resonance (CMR) imaging in clinical practice has grown due to technological advancements and expanded clinical indications, highlighting its superior capabilities when compared to echocardiography for the assessment of myocardial tissue. Similarly, the utilization of implantable cardiac electronic devices (CIEDs) has significantly increased in cardiac arrhythmia management, and the requirements of CMR examinations in patients with CIEDs has become more common. However, this type of exam often presents challenges due to safety concerns and image artifacts. Until a few years ago, the presence of CIED was considered an absolute contraindication to CMR. To address these challenges, various technical improvements in CIED technology, like the reduction of the ferromagnetic components, and in CMR examinations, such as the introduction of new sequences, have been developed. Moreover, a rigorous protocol involving multidisciplinary collaboration is recommended for safe CMR examinations in patients with CIEDs, emphasizing risk assessment, careful monitoring during CMR, and post-scan device evaluation. Alternative methods to CMR, such as computed tomography coronary angiography with tissue characterization techniques like dual-energy and photon-counting, offer alternative potential solutions, although their diagnostic accuracy and availability do limit their use. Despite technological advancements, close collaboration and specialized staff training remain crucial for obtaining safe diagnostic CMR images in patients with CIEDs, thus justifying the presence of specialized centers that are equipped to handle these type of exams.
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Affiliation(s)
- Marco Fogante
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (P.E.P.); (F.C.); (G.A.)
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Paolo Esposto Pirani
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (P.E.P.); (F.C.); (G.A.)
| | - Fatjon Cela
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (P.E.P.); (F.C.); (G.A.)
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Adelina Selimi
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Michele Alfieri
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Leonardo Brugiatelli
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Sara Belleggia
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Francesca Coraducci
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Giulio Argalia
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (P.E.P.); (F.C.); (G.A.)
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Nicolò Schicchi
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy;
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Moustaki M, Markousis-Mavrogenis G, Vryonidou A, Paschou SA, Mavrogeni S. Cardiac disease in Cushing's syndrome. Emphasis on the role of cardiovascular magnetic resonance imaging. Endocrine 2024; 83:548-558. [PMID: 38129722 DOI: 10.1007/s12020-023-03623-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Cushing's Syndrome (CS) is associated with increased cardiovascular morbidity and mortality. In endogenous CS, cardiovascular mortality remains increased for up to 15 years post remission of hypercortisolism. Similarly, patients with exogenous CS have 4-fold increased incidence of cardiovascular events, regardless of pre-existing cardiovascular disease (CVD). OBJECTIVE To present the pathophysiology, prognosis, clinical and imaging phenotype of cardiac disease in CS. METHODS A Pubmed search for cardiac disease in CS over the last 20 years was conducted using combinations of relevant terms. Preclinical and clinical studies, as well as review papers reporting on subclinical heart failure (HF), cardiomyopathy, coronary heart disease (CHD), and cardiovascular imaging were selected. RESULTS Cardiac disease in CS is associated with direct mineralocorticoid and glucocorticoid receptor activation, increased responsiveness to angiotensin II, ectopic epicardial adiposity, arterial stiffness and endothelial dysfunction, as well as with diabetes mellitus, hypertension, hyperlipidemia, obesity and prothrombotic diathesis. Subclinical HF and cardiomyopathy are principally related to direct glucocorticoid (GC) effects and markedly improve or regress post hypercortisolism remission. In contrast, CHD is related to both direct GC effects and CS comorbidities and persists post cure. In patients without clinical evidence of CVD, echocardiography and cardiac magnetic resonance (CMR) imaging reveal left ventricular hypertrophy, fibrosis, diastolic and systolic dysfunction, with the latter being underestimated by echocardiography. Finally, coronary microvascular disease is encountered in one third of cases. CONCLUSION Cardiovascular imaging is crucial in evaluation of cardiac involvement in CS. CMR superiority in terms of reproducibility, operator independency, unrestricted field of view and capability of tissue characterisation makes this modality ideal for future studies.
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Affiliation(s)
- Melpomeni Moustaki
- Department of Endocrinology and Diabetes Center, Hellenic Red Cross Hospital, Athens, Greece.
| | - George Markousis-Mavrogenis
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes Center, Hellenic Red Cross Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophie Mavrogeni
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
- Onassis Cardiac Surgery Center, Athens, Greece
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Markousis-Mavrogenis G, Vartela V, Mavrogeni SI. With a single 'wave of the wand': cardiovascular magnetic resonance transforms the diagnostics of acute coronary syndrome. Eur Heart J Cardiovasc Imaging 2023; 25:16-17. [PMID: 37611214 DOI: 10.1093/ehjci/jead215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- George Markousis-Mavrogenis
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Vasiliki Vartela
- Department of Cardiology, Onassis Cardiac Surgery Hospital, 50 Esperou Str, P. Faliro, 17561 Athens, Greece
| | - Sophie I Mavrogeni
- University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
- Department of Cardiology, Onassis Cardiac Surgery Hospital, 50 Esperou Str, P. Faliro, 17561 Athens, Greece
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Mavrogeni SI, Markousis-Mavrogenis G, Bacopoulou F, Chrousos GP. Cardiovascular Magnetic Resonance Imaging as an Adjunct to the Evaluation of Cardiovascular Involvement in Diabetes Mellitus. J Pers Med 2023; 13:jpm13050724. [PMID: 37240894 DOI: 10.3390/jpm13050724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/13/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
Diabetes mellitus (DM) is a new epidemic which has presented an immense increase in recent decades, due to the rapid increase in obesity. Cardiovascular disease (CVD) significantly reduces life expectancy and is the main cause of death in type 2 diabetes mellitus (T2DM). Strict glycemic control is a well-established method to combat microvascular CVD of type 1 diabetes mellitus (T1DM); its role against CVD of the T2DM risk has not been well documented. Therefore, the most efficient prevention is multifactorial risk factor reduction. Recently, the European Society of Cardiology published its 2019 recommendations on CVD in DM. Although all clinical points were discussed in this document, only a few comments were presented about when and how we should recommend cardiovascular (CV) imaging. Currently, CV imaging is the "must" in CV noninvasive evaluation. Alterations in CV imaging parameters can lead to early recognition of various types of CVD. In this paper, we briefly discuss the role of noninvasive imaging modalities, emphasizing the benefits of including cardiovascular magnetic resonance (CMR) in the evaluation of DM. CMR, in the same examination, can provide an assessment of tissue characterization, perfusion and function, with excellent reproducibility and without radiation or limitations, due to the body habitus. Therefore, it can play a dominant role in the prevention and risk stratification of DM. The suggested protocol for DM evaluation should include routine annual echocardiographic evaluation of all DM patients and CMR assessment of those with poorly controlled DM, microalbuminuria, heart failure, arrhythmia and recent alterations in clinical or echocardiographic evaluation.
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Affiliation(s)
- Sophie I Mavrogeni
- Onassis Cardiac Surgery Center, 17674 Athens, Greece
- University Research Institute of Maternal and Child Health and Precision Medicine, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
| | | | - Flora Bacopoulou
- University Research Institute of Maternal and Child Health and Precision Medicine, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
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